Provider Demographics
NPI:1558308940
Name:CHEEVER, MICHELE (CNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:CHEEVER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 FRANKLIN AVE
Mailing Address - Street 2:#4500
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3551
Mailing Address - Country:US
Mailing Address - Phone:309-828-1166
Mailing Address - Fax:309-862-0330
Practice Address - Street 1:1302 FRANKLIN AVE
Practice Address - Street 2:#4500
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3551
Practice Address - Country:US
Practice Address - Phone:309-828-1166
Practice Address - Fax:309-862-0330
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005750363LC0200X, 363LF0000X
IL309.003039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL112165OtherHEALTH ALLIANCE
IL05732097OtherBC GROUP NUMBER
IL112165OtherHEALTH ALLIANCE
ILP00297898Medicare ID - Type UnspecifiedRR MEDICARE NUMBER
IL212636Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK27061Medicare ID - Type Unspecified